Published 2016-03-23
septa surya wahyudi Sunaryo Hardjowijoto Doddy M Soebadi Soetojo Soetojo Tarmono Djojodimedjo Budiono Budiono


Objective: To investigate whether total cholesterol and C-reactive protein levels could be use as a prognostic factor for outcome in patients with urosepsis. Material & Methods: An analytic observational study using 30 patients assigned for total cholesterol and CRP level at the day of admission, three days later, and on the last day of sepsis or on the dead day. All subjects were managed according to standard urosepsis therapy. At the 14th day of treatment, patients were evaluated with a clinical severity score. Then we classified the outcome as improve/good condition, worse, and died. The variables were statistically tested using Spearman’s rho test with software SPSS 20. P < 0.05 was consider significant. Result: From 30 subjects with urosepsis, we found 15 patients in septic condition, 14 patients had severe sepsis and one patient had septic shock. The mean of total cholesterol level in patient with died and worse was lower than that in patient with good outcome. Day-1 (63.25 mg/dl and 101.38 mg/dl vs 119.5 mg/dl), day-3 (56.0 mg/dl and 93.6 mg/dl vs 128.6 mg/dl) and last day/died day (51.0 mg/dl and 82.25 mg/dl vs 154.8 mg/dl). The mean of CRP level in patient with died and worse was higher than that in patient with good outcome. Day-1 (177.18 mg/l and 146.74 mg/l vs 88.1 mg/l), day 3 (127.1 mg/l and 148.8 mg/l vs 56.2 mg/l) and last day/died day (141.88 mg/l and 88.71 mg/l vs 31.58 mg/l). These were statistically significant between total cholesterol and CRP levels in determining the outcome of urosepsis patient. Day-1 (p 0.000 vs 0.011), day-3 (p 0.000 vs 0.002), and last day/died day (p 0.000 vs 0.000). The coefficient correlation total cholesterol was better than CRP in day-1 (rho -0.633 vs 0.459), day-3 (rho -0.755 vs 0.543), and last day/died day (rho -0.874 vs 0.686). Conclusion: Low total cholesterol and high C-reactive protein levels can be used as poor prognostic in urosepsis patients. Total cholesterol level was better than CRP as a prognostic marker.



Urosepsis outcome, prognostic marker, cholesterol level, C-reactive protein level


Wagenlehner FME, Pilatz A, Weidner Wolfgang. Urosepsis from the view of the Urologist. Int J Antimicrob Agents. 2011; 385: 51-7.

Pierrakos Charalampos, Vincent J Louis. Sepsis biomarker: A review. Crit Care. 2010; 14: R15.

Memis Dilek, Gursoy Olcay, Tasdogan Muhittin, Sut Necdet, Kurt Imran, Ture Mevlut, et al. High C-reactive protein and low cholesterol levels are prognostic markers of survival in severe sepsis. J Clin Anesth. 2007; 19: 186-91.

Marshal John C, Reinhart Konrad. Biomarkers of Sepsis. Crit Care Med. 2009; 37: 2290-8.

Chauffard A, Richet C, Grigaut A. La cholesterinemia aucours de la tuberculose pulmonaire. Compt Rend Soc Biol; 1911. p. 276-7.

Giovannini I, Boldrini G, Chiarla C, Giuliante F, Vellone M, Nuzzo G. Pathophysiologic correlates of hypocholesterolemia in critically ill surgical patients. Intensive Care Med. 1999; 25: 748-51.

Gordon BR, Parker TS, Levine DM, Saal SD, Wang JCL, Sloan B, et al. Relationship of hypolipidemia to cytokine concentrations and outcomes in critically ill surgical patients. Crit Care Med. 2001; 29: 1563-8.

Levels JH, Abraham PR, Van DE, Van DSJ. Distribution and kinetics of lipoprotein-bound endotoxin. Infect Immun. 2001; 69: 2821-8.

Chiarla Carlo, Giovannini Ivo, Giuliante Felice, Zadak Zdenek, Vellone Maria, Ardito Fransesco, et al. Severe hypocholesterolemia in surgical patients, sepsis, and critical illness. J Crit Care. 2010; 25: 361.e7-.e12.

Fraunberger P, Pilz G, Cremer P, Werdan K, Walli AK. Association of serum tumor necrosis factor levels with decrease of cholesterol during septic shock. Shock. 1998; 10: 359-63.

Iman D, Pudjirahardjo WJ, Anniwati L, Santoso A, Hardjowijoto S. Perbedaan kadar laktat plasma dibandingkan dengan c-reactive protein (CRP) sebagai indikator dalam menentukan prognosis pasien dengan urosepsis. Department of Urology, Faculty of Medicine/Airlangga University; 2014.

Starr Marlene E, Saito Hiroshi. Sepsis in old age: Review of human and animal studies. Aging Dis. 2014; 5(2): 126–36.

Serniak P, Denisov V, Guba GB, Zakharov V, Chernobrivtsev P, Berko E. The diagnosis of urosepsis. Urol Nefrol; 1990. p. 9-13.

Nguyen H. Bacterial infections of the genitourinary tract. In: Tanagho EA, ed. Smith’s General Urology. 17th ed. New York: McGraw–Hill Companies; 2008. p. 193-200.

Povoa P, Almeida E, Moreira, Fernandes, Melha, Aragao. C–reactive protein as an indicator of sepsis. J Intensive Care Med. 1998; 24: 1052-6.

Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999; 17: 1019-25.

Suzana MA Lobo, Francisco RM Lobo, Daliana Peres Bota, Flavio Lopes Ferreira, Hosam M Soliman, Christian Melot, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest J. 2003; 123: 2043-9.

Criqui Mh. Very low cholesterol and cholesterol lowering: American Heart Association; 1994.

Das Sabari, Bhargava Seema, Manocha Anjali, Kankra Mamta, Ray Sumit, Srivastava L Mohan. The prognostic value of hypocholesterolemia in sepsis. Asian J Pharm Biol Res; 2011.

Van Lenten BJ, AM Fogelman, ME Haberland, PA Edward. The role of lipoprotein and receptor mediated endocytosis in the transport of bacterial lipopolisaccharide. Proc Natl Acad Sci USA. 1986; 83: 2704-8.

Wurfel Mark M, Kunitake Steven T, Lichenstein H, Kane JP, Wright SD. Lipopolysaccharide (LPS)-binding protein is carried on lipoprotein and acts as a cofactor in the neutralization of LPS. J Exp Med. 1994; 180: 1025-35.

Dhillon SS, Mahadevan K, Bandi V. Neutrophils, nitric oxide and microvascular permeability in severe sepsis. J Chest. 2005; 128: 1706-12.

Ettinger Wh, Varna Vk, Sorci-Thomas M, Parks J, Sigmon R, Smith Tk, et al. Cytokines decrease apolipoprotein accumulation in medium from Hep G2 cells. Arterioscler Thromb. 1994; 14: 8-13.

Kitazawa Takatoshi, Yanagimoto S, Tatsuno K, Fukushima A, Okugawa Shu, Ota Yasuo. Serum cholesterol levels at the onset of bloodstream infection have prognostic value. Advances in Infectious Disease. 2012; 2: 100-5.

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Department of Urology, Faculty of Medicine/Airlangga University